Are Americans Getting Smarter About Obesity?

This is TELL ME MORE from NPR News. I'm Michel Martin. Later this hour, we're going to deal with some common holiday dilemmas, such as how to deal with tantrums at the mall, how to deal with people who get a little too cute at a holiday gathering and how to move your spending habits from the naughty to nice column, at least for next year. That's all coming up.

But first, another issue that often comes up at holiday time, which is health, especially in the area of excess weight. It is now widely understood that obesity has become a significant health concern in recent years. It's now considered one of this country's major health threats, affecting everything from chronic conditions like diabetes to the recruitment of America's troops. But now some good news, according to an annual survey of America's health, for the first time in decades the nation's obesity rate remained flat between 2012 and 2013. The report also says that more Americans are exercising. With us now to talk about all this is Dr. Reed Tuckson. He is medical advisor to the United Health Foundation, which sponsors America's Health Rankings. He's with us from Atlanta. Dr. Tuckson, thanks so much for joining us once again.

REED TUCKSON: It's a great pleasure.

MARTIN: And we're also joined by Andrew Williams, professor and distinguished chair at the College of Engineering at Marquette University in Wisconsin. We called him because he has some fresh ideas about how to get children to exercise more. Professor Williams, thank you so much for joining us.

ANDREW WILLIAMS: Thank you, Michel.

MARTIN: So let me start with you, Dr. Tuckson. You are also a former public health official, so you're kind of well-grounded in this area. The survey says that for the first time since 1998, obesity rates did not increase. The rate barely changed from 27.6 percent to 27.8 percent in 2013. Now that's still a lot of people carrying excess weight. Why are we thinking this is good news?

TUCKSON: Well, the good news only is that we finally needed some encouragement, some signs of progress. And so the fact that it didn't get marginally - it didn't go up in any significant way is extremely important. That combined with the fact that it was a pretty significant decrease in the number of Americans who are couch potatoes. The people who get no further exercise other than getting up and going to work decreased from 26.2 percent of the population to 22.9.

So we sort of look at that along with the fact that this year the smoking rates also significantly decreased from 21 percent down to 19.6. So what we're wondering and beginning to get encouraged by, as we look at obesity, is that maybe we are starting as a nation to get the message that we've got to get active and change some of these statistics.

MARTIN: Now, Hawaii, it tops the list. I mean, the survey looks at data state-by-state. Hawaii ranked as the healthiest - first time for that state - although it's always been kind of in the top. Mississippi is, once again, the lowest ranked. Are there attributes that are common to either the healthiest states and to the states that are ranked as the least healthy?

TUCKSON: There is no question that one of the variables in healthiness and the chances to be healthy are socioeconomic status. Individuals who are more well-off economically, by in large, tend to take better care of themselves, are more optimistic about the future. They feel more in control over their environments. They have a clearer sense in their mind that there is a direct relationship to the actions they take and the future that they envision for themselves.

Similarly, the resources that are available to promote health, in terms of healthy communities and healthy work environments, are definitely related to the amount of money that the state government may have, the work environment and philanthropy, so all of those things are certainly related. We clearly see it the most in obesity. If we look at high school graduation rates, there is a phenomenal relationship between people who have not graduated from high school, those who have graduated, those who have attended some college and those who have graduated from college. As you move across that continuum with obesity, the numbers fall off dramatically.

MARTIN: You know, it's interesting, though, is that Hawaii scored - lost points for a high prevalence of binge drinking, but also low high school graduation rates. So why do you think that Hawaii still managed to come out on top as the healthiest state, at least for this year's rankings....

TUCKSON: Right.

MARTIN: ...Despite that one indicator, which you said is surprisingly important?

TUCKSON: Yeah.

MARTIN: I mean, I'm glad you explained that, I think, 'cause some people might be wondering, why is this that high school graduation rates are part of a health survey.

TUCKSON: Right.

MARTIN: So why does, do you think, that Hawaii still managed to score very high despite the fact that it does have a lower...

TUCKSON: Yeah.

MARTIN: ...High school graduation rate?

TUCKSON: It is difficult from the vantage point nationally for us to know that. But the obvious answer - and I can't explain all of the reasons underneath it - but the obvious issues are that, for whatever reason, people in Hawaii have made the choice to live healthier lives. Also, it means that the community in which they are living are just, by whatever reason, healthier environments. The decisions being made by their elected and public officials are also more conducive to health. So when you put all those together, they are enjoying a much more healthier existence.

MARTIN: If you're just joining us, we're talking about the results of this year's Health Rankings survey. It found that obesity rates in the U.S. were flat this year, which is good news because the obesity rate has actually been rising every year since the late 1990s. Let's bring Professor Andrew Williams into the conversation now. We've been talking about the, mainly, you know, adult obesity and exercise issues. But we know that children in the U.S. - the health of America's children are a significant concern.

That's been a particular focus of the first lady, Michelle Obama. You and your students are working on something that you hope will help kids be more active and fit. It's a robot. Tell us a little bit more about why you think this is a good idea.

WILLIAMS: So kids naturally like to engage with toys, and the particular robot that we're developing is a two foot tall robot that can talk to them. It can listen to them, understand their commands and actually demonstrate exercises and exercise with them.

MARTIN: Well, why do you think this is helpful? I mean, you already have things like - there are video games, for example, that you can model, exercise with, you know - I don't play video games, so why am I pretending that I know what I'm talking about. There's Wii - there was a Wii - I think there are a number of games where I think you can kind of pretend to surf and do dance and stuff like that. I mean, what do you think this adds to that mix, Professor Williams?

WILLIAMS: Right. In fact, we want to work in cooperation with them. But one of the most effective ways to intervene for obesity is a personal trainer or a personal health coach. And those are expensive. And our vision is to have a low-cost, humanoid robot health coach that can be in every classroom and eventually in every home.

MARTIN: Personal trainer robot, interesting - Dr. Tuckson, can I ask you, what do you think about this? I mean, I'm interested in what your - what does the research show? What is your understanding -show about why it is that some kids are more likely to exercise than others?

TUCKSON: One of the things that I found to be very exciting - and what's encouraging about this - is bringing innovation to bear. You know, this country - we have so many exciting ways of engaging people today using new various forms of technologies that it's been frustrating in the past that public health and disease prevention has been sort of boring. You know, here's our newsletter. Here's our brochure. Here's our pamphlet.

You know, public-service commercials - all of which, you know, have their place. But the new games that you mention, like Wii and "Dance Dance Revolution" - and these kinds of things that use modern, innovative ways of engaging people and kids instead of having, you know, to say to a young person, here is a dose of exercise. Now, you go get this, take your medicine. Or you could say, let's have fun. Let's do some kind of a gaming technology. Let's play with a robot. Let's have a conversation that makes it fun. I'm encouraged by that kind of innovation. I wish more of our smart innovators from outside of health would decide to become deputized in the health fight.

MARTIN: Do you think that, Professor Williams, that's in part, though - because one of the things that's intriguing to a lot of people about this is kids are the last people who you would think would need more encouragement to exercise 'cause they naturally seem to want to go out and run and play and be active. And we've heard different arguments in recent years about why there is less of that happening. And one of the arguments for some people is safety - physical safety - that a lot of kids don't have a safe place outside to run and play, particularly after school hours. Is it your thought, Professor Williams, that this is something that a child could do indoors in his or her own home or at school?

WILLIAMS: Yes. In fact, in our pilot study, we worked with higher-aged teens. And the exercises that they did were indoors. They went through a 30 minute exercise routine with the humanoid robot health coach while wearing Nike FuelBands, or accelerometers, to keep track of their physical activity during the week. And so what we found - that on average the students that engaged with the humanoid health coach versus a human robot - just a human health coach - on average, they had higher physical activity.

MARTIN: Interesting. So, Dr. Tuckson, we only have about two minutes left. Are there other signs that you would want to point to in this ongoing effort to address the problem of excess weight or obesity in the United States that you want to point to? Are there other things you're particularly encouraged by? And are there things that you're discouraged about at the moment?

TUCKSON: I'm encouraged by the fact that, finally, we're beginning to see across-the-board multi-segment activity. So I'm glad about the things that are happening in our schools. I think the first lady's activities are very important. I'm encouraged by the innovations like "Dance Dance Revolution," the Wii fit games, and bringing those into the classroom. I'm involved in doing that in about six school systems around the country and I'm seeing it work.

I'm also encouraged, though, by what's happening in the workplace. Many more employers have now gotten the message around - changing the cafeteria menus, creating walking paths for their employees, and creating new incentives in their health insurance benefits that encourage that. I'm encouraged by what's happening in our community environments, as we are really beginning as a nation to make the commitment to walking trails and biking trails and making those resources. The area that I think we still have a lot of work to do is in the retail food industry. We have to - especially for inner-city communities - we've got to continue to work hard on making available healthy foods at an affordable price in a convenient way, and try to do something about this increasing plethora of fast foods. That's an area that I think we need much more work.

MARTIN: Dr. Reed Tuckson is the medical advisor to United Health Foundation. It sponsors America's Health Rankings. And he was with us on the phone from Atlanta. Professor Andrew Williams directs the Humanoid Engineering & Intelligent Robotics Lab at Marquette University, which is in Wisconsin. He joined us from the studios of Wisconsin Public Radio in Milwaukee. Thank you both so much for joining us.